The Great Recession had dramatic and visible effects: Millions of Americans lost their homes; more than 8 million people lost their jobs. But a new study finds that it also had invisible effects on people’s health — and that those effects could have long-term consequences.

Using a long-running study on heart health, scientists evaluated blood pressure and blood glucose measurements from 2000 to 2012. They found that those metrics were significantly worse after the recession hit in 2007 — at least in part due to fewer people taking their medicines.

The finding provides some of the strongest evidence yet that economic stress can have a negative effect on people’s health. “Here in the U.S., we’re not very responsive to economic downturns,” said study author and University of California, Los Angeles, epidemiologist Teresa Seeman. “But we particularly don’t pay much attention to the health consequences.”

advertisement

These data, she said, indicate that we might want to take a closer look. “To me, this study is ringing a bell and showing that it’s more than just economic, health needs to be a concern as well.”

Well-timed data collection

Seeman and her colleagues had been gathering data for years from more than 4,500 middle-aged and older people for the Multi-Ethnic Study of Atherosclerosis, or MESA. MESA was originally designed to suss out how heart disease may develop differently across racial and ethnic groups. But by chance, MESA’s data collection was timed nearly perfectly to pick up on the recession’s impact, too. The team assembled four sets of data before the recession, including one that wrapped up in May 2007. They started collecting again in June 2010 — one year after the recession officially ended.

They found that people who were younger than 65 and on medication when the recession hit saw their systolic blood pressure go about 12 mmHg above where it would have risen due to aging alone. People who were younger than 65 taking medication also saw an unexpected increase in their blood glucose levels of about 11 percent as of 2012, the latest year the analysis included.

Blood pressure and glucose levels are ideal metrics for researchers studying the impact of a short-term shock, like a major two-year recession. Both change over a relatively short time frame, and both are known to be physiological responses to stress.

Sign up for our Daily Recap newsletter

Increases in both measurements can be linked to an increased risk of heart disease, Seeman said.

The groups that showed some of the largest increases — adults who were likely working but approaching retirement and older, educated homeowners — are exactly the people who were likely to be hit hardest by the recession’s effects. “If anybody suffered economically more than others, these are the people it would have hit,” Seeman said. Middle-class homeowners were “particularly vulnerable to the housing market crash,” according to the U.S. National Bureau of Economic Research.

It’s not a huge leap to assume financial strain might be linked with health problems. Stress, for one thing, is known to take a toll on a person’s well-being. And losing a job and the health insurance that comes with it might mean making tough choices about money spent on food or health care, including medications. In fact, 17 percent fewer adults over 65 were taking blood pressure medication after the recession in this study. The number of elderly people who were taking insulin also decreased by about 13 percent.

The paper was published Monday in Proceedings of the National Academy of Sciences.

“Medications tend to be relatively expensive for most of us,” Seeman explained — even for people eligible for Medicare. “Unfortunately, high blood pressure and high levels of glucose tend to be non-symptomatic, by and large. Not taking your medication, you wouldn’t necessarily start feeling the consequences of that.”

A lack of research

Hard data about the recession’s impact can be hard to find; the Great Recession and its impact on health and health care systems accounted for only 92 published papers in the last two years. Among them is one published by Jessica Jones-Smith, an epidemiologist at the University of Washington’s School of Public Health. In 2016, she and her colleagues published a paper finding that children were at a higher risk of gaining weight during the recession if they lived in counties where unemployment rose.

In fact, Jones-Smith noted, recessions can be a valuable opportunity for public health research. “The recession allows enough variation in economic conditions to say something about how they might impact health,” she said.

Jones-Smith called Seeman’s paper “probably one of the strongest papers on the recession.” However, some questions remain unanswered. It won’t be clear if the effects found are temporary until more data is collected. Seeman and her colleagues will also need to wait and watch their cohort before they can say whether these changes might actually lead to more heart attacks than expected.

The study cohort wasn’t designed to be nationally representative, Seeman noted, so the results might not be generalizable to the entire country. The paper didn’t include an analysis of whether a person’s health outcomes varied by their racial or ethnic identity — which could matter, especially given that rates of home ownership in the United States do vary widely between groups.

Finally, Jones-Smith noted, the study could have been even stronger if Seeman and her colleagues had analyzed their data based on foreclosure rates in a person’s neighborhood — which is exactly what Seeman and her team is planning to do next, pending funding.

Unfortunately, Seeman’s research could be relevant again someday. Economic downturns are cyclical — which means another will come. What we do as a society in the face of it, however, is under our control. The health consequences of recessions have been overlooked in the past, Seeman said. But perhaps that won’t be true for much longer.

Nice study. Other studies demonstrate that there are populations that have been in permanent recession – populations that have the poor outcomes expected.

Racial or ethnic identity often shows differences, but this can be the lack of data specific to the individual regarding their specific social determinants, situations, and conditions.

Matching up individuals to local mortgage rates or local income or other substituted proxy variables is not the same as a study with all data specific to the individual. This also magnifies the impact of race and ethnicity as seen in cancer data where the only specific data is race and ethnicity and the outcome measured.